Souichi Shioguchi

Venous drainage method for cardiopulmonary bypass in single-access minimally invasive cardiac surgery: siphon and vacuum-assisted drainage.

Vacuum-assisted venous drainage (VAVD) can facilitate venous drainage in single-access minimally invasive cardiac surgery (SAMICS). We retrospectively examined the use of VAVD in SAMICS in our hospital for this report. VAVD has been performed according to a VAVD protocol since 2000. Data from the 110 patients who underwent SAMICS in our institute from January 2000 to June 2002 were reviewed retrospectively. The total negative pressure was maintained at no greater than −90 mmHg. Indications for use of VAVD (protocol) were: insufficient venous return by siphon drainage alone, persistent elevation of the central venous pressure (CVP), and, insufficient venous drainage in the operative field. Of 110 patients, 97 (88.2%) underwent VAVD. The body surface area was significantly smaller in the group that did not require VAVD (the non-VAVD group) than in the group that did (VAVD group) (VAVD group versus non-VAVD group: 1.586 ± 0.175 versus 1.408 ± 0.153 m2, P < 0.001). Other factors such as cardiopulmonary bypass time, aortic cross-clamp time, postoperative maximum lactate dehydrogenase, postoperative maximum creatinine, postoperative maximum blood urea nitrogen were similar in the two groups. VAVD is necessary in SAMICS except for small patients. A VAVD total negative pressure of −90 mmHg did not hinder operative procedures or cause clinical problems.

Multiple papillary fibroelastoma of the left ventricle.

treatment of a brain infarction. The transesophageal echocardiography (TEE) showed a mobile, solitary, intracavitary tumor with a short pedicle arising from the left ventricular outfl ow just below the right coronary cusp (Figure 1). It was considered to be the cause of the brain infarction. To avoid any further embolization, the patient was transferred to our hospital for urgent operation. At surgery, the aortotomy was performed under cardiopulmonary bypass and a 5 mm in diameter video-assisted thoracoscope (Olympus, Japan) was introduced through the aortic valve for inspecting the left ventricular cavity. A tumor measuring IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY

Usefulness of Lower Ministernotomy in Aortic Valve Replacement (AVR) by Minimary Invasive Cardiac Surgery (MICS)

Minimary invasive cardiac surgery (MICS)による大動脈弁置換術(AVR)においては一般的にupper ministernotomyが選択されることが多い.しかし,retograde cardioplegia cannulaが挿入できないことなどがある.当科でCTをもとに検討したところ日本人の大動脈弁の位置はlower ministernotomyでも手術可能な場合が多いことがわかった.そこでこの2種のアプローチの有用性について検討した.1997年1月から2002年3月までに大動脈弁疾患に対しMICSによるAVRを施行した68症例を対象としupper ministernotomy施行症例をU群,lower ministernotomy施行症例をL群とした.Retrograde cardioplegiaは一般にAVRでの心筋保護法として頻用されている.L群は心筋保護および術野確保の点でもfull sternotomyへの移行した症例はなく有効であった.L群ではMAZE手術も施行でき大動脈遮断時間,人工心肺時間,手術時間,出血量,そのほかの因子でも有意差を認めなかった.Lower ministernotomyはupper ministernotomyと比較しMICS AVRにおいてretrograde cardioplegiaによる心筋保護および術野確保に有効であった.